Abstract
Vitamin A deficiency and malaria are both highly prevalent health problems in Africa. Vitamin A deficiency affects over 30 million children, most of whom are in the age-group (under five years) most affected by malaria. Vitamin A deficiency increases all-cause mortality in this part of the population, and malaria is an important cause of death in children at this age. A low serum retinol concentration (a marker of vitamin A deficiency) is commonly found in children suffering from malaria, but it is not certain whether this represents pre-existing vitamin A deficiency, a contribution of malaria to vitamin A deficiency, or merely an acute effect of malaria on retinol metabolism or binding. In this paper, available evidence in support of a causal relationship in each direction between vitamin A deficiency and malaria is reviewed. If such a relationship exists, and especially if this is bidirectional, interventions against either disease may convey an amplified benefit for health.
Highlights
Malaria commonly afflicts populations that are both impoverished and malnourished, and a large proportion of the burden of malaria falls upon children
Children who had suffered from diarrhoea or respiratory disease were more likely to develop xerophthalmia subsequently [32]. These findings suggest that a reduction in the serum retinol concentration may follow a variety of acute infections, presumably mediated by a common host response
Is the plasma retinol concentration during an acute infectious illness of any value as an indicator of an individual's vitamin A status? A prospective study [45] assessing the clinical and laboratory measurements at admission and recovery of 90 children with dysentery (66 with shigellosis) hospitalized in Bangladesh showed that serum retinol concentrations were low at admission, but were significantly greater at discharge even though no vitamin A supplements were given during the illness (0.36 +/- 0.22 compared with 1.15 +/- 0.50 μmol/L; or 10.3 +/- 6.3 compared with 33 +/-14.3 μg/dl P < 0.001)
Summary
Malaria commonly afflicts populations that are both impoverished and malnourished, and a large proportion of the burden of malaria falls upon children. A prospective study [45] assessing the clinical and laboratory measurements at admission and recovery of 90 children with dysentery (66 with shigellosis) hospitalized in Bangladesh showed that serum retinol concentrations were low at admission, but were significantly greater at discharge even though no vitamin A supplements were given during the illness (0.36 +/- 0.22 compared with 1.15 +/- 0.50 μmol/L; or 10.3 +/- 6.3 compared with 33 +/-14.3 μg/dl P < 0.001) The extent of this increase was significantly associated with severity of disease and was greatest in children with poor underlying nutritional status, those with a low weightfor-age. There seems to be no data showing whether or how soon retinol levels are restored after a malaria infection has been eliminated, or of any investigations of the possibility that the low retinol levels in these circumstances, even if transient, may further increase susceptibility to malaria or other infections
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